Adult Cardiac Arrest Circular Algorithm Return of Spontaneous Circulation (ROSC) erate (©2020 American Heart Association + Push hard atleast 2inches [5 em)) and fast (100-120/min| and, allow complete chest recoil + Minimize interruptions in compressions. * Avoid excessive ventilation. * Change compressor every 2 minutes, or sooner f fatigued. * Ifnosdvanced airway, 30:2 comprossion-ventilation ratio. + Quantitative waveform capnography = If PETCO, Is low or decreasing reassess CPR quality. Shock Energy for Defibrillation * Biphasic: Manufacturer recommendation (og, initial dose of 120-200 J): unknown, use maximum available. Second and ‘subsequent doses should be equivalent, and higher doses may be considered, + Monophasic:360 J Exes *+ Epinephrine IV/IO dose: 1 mg every 3-5 minutes, + Amiodarone IV/I0 dose: First dose: 300 mg bolus. Second dose: 150mg, + Lidocaine 1V/10 dose: First dose: 1-15 mg/kg. Second dose: 05-0.75 malig, + Endotrachealintubation or supraglottic advanced airway * Waveform capnography or capnametry to confirm and monitor ET tube placament + Once advanced airway nplace, give 1 breath every6 seconds (10 breaths/min) with continuous chest compressions nee a) * Pulse and biood pressure * Abrupt sustainedincrease in PETCO, (typically 240 mm Hg) * Spontaneous arterial pressure waves with intra-arterial ‘monitoring + Hypovolemia + Tension pneumothorax Hypoxia ‘Tamponade, cardiac + Hydrogen ion acidosis) + Toxns + Hypo-/hyperkalemia + Thrombosis, pulmonary + Hypothermia + Thrombosis, coronaryAdult Cardiac Arrest Algorithm “ Start CPR + Giveoxygen + Attach moritor/doibilator > GS “meznine + CPR2 min + Ino access + Epinephrine every 3-5 min + Consider advancedairway, capnography CPR2 min + Epinephrine every 3-5 min + Consider advancedainway, ccapnography CPR2 min + Amiodarone or lidocaine + Treatreversible causes CPR2 min + Treat reversible causes + Itnosigns of return of Gotosor7 spontaneous crculation - _ (ROSO,, goto 10 or 11 + IFROSC, goto Post-Cardiac Arrest Care + Consider appropriateness cof continued resuscitation + Pushhardiat east 2inches {Sem} and fact 100-120/rnin) ‘andallow complate chest reco + Minmizeinteruntonsin Change compressor every 2iminutes, oF sooner ifetigues ithe advanced airway, 30-2 compresson-ventiation ati, ort breatn every 6 seconds. Guantative waveform capnosianhy PETC, alow or dece reassess CPR quelty, + Biphasie: Manufacturer recommendation 2g tial Secondand subsequent doses should be equivalent, ard higher osesmay beconsidared + Monophasie: 360.) + Epinephrine V/I0 dose: ‘mg every 35 minutes + Amiodarone V/IO dose: Frstdose.200mgboWs, Second dose: 150mg. {docsineto dos Frstdose: 1-15 maf. Second dose'0.5-075mgiKo. + Endotracheal intubation or su praplottc advancedarway + Waveform capnography orcap- rometryto confirm and monitor Ertubepiacement + Once acvanced airway in place give 1 brosthovory 6 soconde {HObreathsimn) wth contin ouschest compressions tae Circulation ROSC) + Puseandblood pressure 1 Abrupt sustained inereasein Petco: typiesly 240 mm Hg) + Spontaneous arteralpressixe waves with intra-arterial monitoring + Hypovoiemia + Hypoxia + HyGragenionjaciaosis), + Hypo-inyperkalemia + Hypothermia + Tension pneumothorax + Temponace, carciac Tous, Thrombosis, pulmonary Thrombosis, coronaryAdult Bradycardia Algorithm Persistent bradyarrhythmia causing: + Hypotension? + Acutelyalteredmental status? + Signs of shock? + Ischemic chest discomfort? Doses/Details| ‘Atropine IV dose: First dose: 1 mg bolus. Repeat every 3-Sminutes. Maximum: m9, Dopamine Vinfusion: Usuatinfusion rate is 5-20 meglkg per minute, Tatrate to patient response; taper owl. Epinephrine IV infusion: 210meg per minuto infusion, Titrate to patient response. caus ‘+ Myocardialischemal Infarction + Drugsstoxicologie fe, Calcium-channe! blockers, betablockers, digoxin) + Hypoxia + Elactrolyteabnormalty (ea. hyperkalemia)Adult Tachycardia With a Pulse Algorithm Doses/Detal ‘Synchronized cardioversion: Refer to your specific device's recommended energylevelto ‘maximize first shock success, ‘Adenosine IV dose: First dose: 6 mg rapid IV pusts follow with NS Tush, Seconddose: 12mgif required “Antiarrhythmic infusions for Stable Wide-QRS Tachycardia Procainamide IV dose: 20-50 mg/min until arrhythmia suppressed, hypotension ensues, {QRS duration increases >50%, or maximum dose 17 mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid prolonged QT or CHF. ‘AmiodaronelV dose: First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs, Follow by maintenance infusion of 1 mg/min or frst hours. Sotalol V dost 100mg (1 Smg/kg) over S minutes. Avoidif prolonged QT. Persistent ‘tachyarrhythmia causing: ++ Hypotension? ‘Acutely altered mental status? + Signs of shock? ©2020 American Heart AssocationACLS Healthcare Provider Post-Cardiac Arrest Care Algorithm Resuscitationis ongoing duringthe post-ROSC phase, andmany of these ~activitios can occur concurrently However, f prioritization is necessary follow these steps: + Airway management: ‘Waveform capnography or Initia! Stabilization ‘capnometry to confer and monitor _ lendotracheal tube placement + Manage respiratory parameters: Titrte Fo, for Spo, 9296-985 start at 1Obreaths/min;titrate to Paco, of 35-45 mmHg + Manage hemodynamic parameters: Administer crystalloid andor vasoptessar or inotrope for goat systolic blood pressure >90 mm Hg ‘ormean arterial prossuro >65 mm Hg tart ey Pern Consider for emergent cardiac intervention if. ciel ier] a ‘ “These evaluations should be done ‘concurrently o that decisions on targeted temperature management (TT) receive high priority as cardiac interventions, + Emergont cardiac intervention: = Continuously monitor core temperature esophageal, rectal bladder) = Maintain normoxia,normocapnia, L euglycemia ~ Provide continuous or intermittent Glactroencephalogram (EES) ‘monitoring ~ Provide lung-protective ventilation Hypovolomia Hypoxia Hydrogen ion (acidosis) Hypokalemia/hyperkalemia Hypothermia ‘Tension pneumothorax ‘Tamponade, cardiac Toxins ‘Thrombosis, pulmonary ‘Thrombosis, coronary (©2020 American Heart AssociationFigure 6. Opioid-Associated Emergency for Healthcare Providers Algorithm. Start CPR + Use an AED. = Considernaloxone. + Refer to the BLS/Cardiac (©2020 American Heat AssociationCardiac Arrest in Pregnancy In-Hospital ACLS Algorithm ‘Continue BLS/ACLS ona cares rac aa Sra petaeamuarsier + Selatan Tegner selon erate enn veneer ommnrones, saan Fa sean gay Oo gitctaomeaalconee: cripple «ea exec corn cherries Spee nes ormeresaction sees Leonean conimohisnces ae ES, = ops (elects ed osetia incl give 1 breath every 6 seconds: Sastre ieee Pennie [Neonatal team toreceive neonate ora ‘A Anesthetic complications B Bleeding © Carciovascular D Drugs E Embolio F Fever 6 General nonobstettic causes of ‘cardiac arrest H's ands} H Hypertension ©2020 American Heart Associaton